Small Bowel Obstruction

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 8, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.25
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 1.75
Abdomen and Pelvis: 1.75

Radiography: 2.25
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 1.75
Thorax and Abdomen Procedures: 1.75

Registered Radiologist Assistant: 2.25
Patient Care: 0.50
Pharmacology: 0.50
Procedures: 1.75
Abdominal Section: 1.75

Sonography: 1.00
Procedures: 1.00
Abdomen: 1.00

Radiation Therapy: 1.50
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 1.00
Treatment Sites and Tumors: 1.00

Outline

1. Introduction
2. Imaging Work-up: Algorithmic Approach
3. Findings at Plain Abdominal Radiography
4. Findings at Sonography
5. Findings at Multidetector CT
6. Is the Small Bowel Obstructed
7. How Severe Is the Obstruction
8. Where Is the Transition Point
9. What Is the Cause of the Obstruction
   1. Intrinsic Causes of SBO
      1. Disease
      2. Neoplasia
      3. Intussusception
      4. Radiation Enteritis
      5. Hematomas
      6. Vascular Causes
   2. Extrinsic Causes of SBO
      2. Hernias
      3. Endometriosis
   3. Intraluminal Causes of SBO
      1. Ileus
      2. Bezoar
      3. Distal Intestinal Obstruction Syndrome
      4. Other Intraluminal Casues
10. Is the SBO Simple or Complicated
11. Conclusions

Objectives

Upon completion of this course, students will:

1. define small bowel obstruction
2. know the questions radiology answers pertaining to SBO
3. understand the typical first step in diagnosing SBO
4. recognize limitations of sonography for assessing SBO
5. learn the roles of each modality and understand which one excels for identifying strangulation
6. recognize the signs and symptoms of a small bowel obstruction
7. understand how often conventional abdominal radiography is non-specific and misleading for SBO
8. learn when immediate surgical evaluation should be performed on SBO
9. learn which patient population would benefit from CT enteroclysis
10. understand the sonographic criteria to identify SBO
11. learn which study is best for examining SBO associated with external hernia
12. understand why multidetector CT plays a primary role in small bowel obstruction
13. realize the questions multidetector CT can answer pertaining to SBO
14. know the criteria that define a dilated bowel loop in CT
15. learn the defining criteria and be able to recognize a high-grade obstruction
16. learn how the effects of time affect the distal segment of a high-grade obstruction
17. learn how positive oral contrast is used to grade the severity of an SBO
18. define the transition point and understand how to identify it
19. be familiar with the “small bowel feces” sign
20. define the different types of small bowel obstructions
21. understand how endoluminal obstructions can occur
22. identify the top causes of SBO in Western society
23. identify intrinsic causes of SBO
24. be familiar with how often small bowel neoplasms are involved in SBO
25. be familiar with radiation enteritis and its resulting effect
26. identify extrinsic causes of SBO
27. be familiar with gallstone ileus
28. be familiar with the appearance of intraluminal obstructions
29. be familiar with some of the causes of small bowel obstruction in children
30. recognize what pneumatosis inestina, and the halo sign are indicative of